A history of the following indicates what cause?
- Pain aggravated by change of position, prolonged sitting, getting up, ending and lifting.
- Triggering event.

Mechanical.

A history of the following indicates what cause?
- History of malignancy.
- Unexplained weight loss.
- Visit to the doctor in the last month and not improving.

Malignancy.

A history of the following indicates what cause?
- Pain > 3 months and morning stiffness > 1/2 hour and <35 years old.

Inflammation.

A history of the following indicates what cause?
- IV drug use or recent discogram or fever.

Infection.

A history of the following indicates what cause?
- Significant trauma.

Fracture.

A history of the following indicates what cause?
- Sharp pain following nerve pathways.
- Leg pain extending to below the knee.
- Dermatomal paresthesia.
- Localised weakness.

Radiculopathy.

A history of leg pain on walking relieved by rest or lumbar flexion indicates what possible cause?

Spinal stenosis or vascular disease.

A history of associated urinary, gynaecological or GIT symptoms indicates what possible cause?

Viscerogenic pain or referred somato-visceral relationship.

A history of bilateral leg pain and sphincter disturbance indicates what possible cause?

Cauda equina compression.

A history of pain worse on standing and walking, but relieved by sitting indicates what possible cause?

Spondylolisthesis.

What is the normal angle for lumbar extension?

20-30 degrees.

What is the normal angle for lumbar flexion?

80-90 degrees.

What is the normal angle for lateral flexion?

30 degrees.

What is the general order for palpation of the back?

Palpation aims to identify the level and side of maximum tenderness and stiffness, as well as to correlate it with other signs and symptoms. The order is:
- Light touch first to gauge increased muscle tone and skin hypersensitivity.
- Central palpation over spines and interspinous ligaments.
- Over facet joints.
- Sacroiliac joints.
- Muscles, especially the gluteus medius/minimus (L5) and piriformis (S1), for tender/trigger points.

- Some short term benefit for neck pain and headache.
- Similar to TENS or soft collar with analgesics.
- Mobilisation similar to salicylate and better than massage and traction.
- No different to physio or GP care in chronic pain.

Is there any good evidence for the efficacy of simple analgesics and NSAIDs in neck pain?

No good evidence.

Is there any good evidence for the efficacy of diazepam and phenobarbital in neck pain?

No evidence.

Is there any good evidence for the efficacy of electromagnetic therapy in neck pain?

More 'moderately better' patients.

What is the pathophysiological mechanism behind whiplash?

Sudden, unexpected impact with neck structures unprotected by muscles - most commonly flexion-extension with reflex whipping action of the anterior muscles.
- Macro and microtrauma to discs, joints, and soft tissues usually missed by investigations.
- The lower back may also become affected with more severe trauma.

What are the common clinical presentation of whiplash?

- Headache and shoulder pain.
- Pain and tenderness is more diffuse and also anteriorly as well as posteriorly.
- Upper neck extension typically most affected.
- Delayed onset, but risk of chronicity higher than for 'usual' neck pain.